Cancer is the leading killer of people with diabetes in England.
This is the result of an 18-year study of over 300,000 people with diabetes in England, conducted by scientists at Imperial College London and published in The Lancet Diabetes & Endocrinology.
February 4th is World Cancer Day.
Improvements in risk factors such as smoking and blood pressure, as well as advances in medical treatments, have contributed to sharp decreases in deaths from heart disease and stroke. Dr. Jonathan Pearson-Stuttard author of the study
The study, funded by the Wellcome Trust, shows that heart disease and stroke were no longer the main causes of death in people with diabetes between 2001 and 2018, as they were 18 years ago.
Diabetes affects 4.7 million people in the UK and is caused by the body’s inability to regulate blood sugar levels. Around 90 percent suffer from type 2 diabetes, which is linked to lifestyle factors such as high blood pressure and obesity.
The rest have type 1 diabetes, which is caused by the body attacking the cells that produce insulin, the hormone that controls blood sugar.
In the study, researchers from the Imperial School of Public Health examined anonymized primary care data of 313,907 people in England with diabetes between 2001 and 2018 and linked them to death data from the Office of National Statistics.
The study found that the death rate of diabetics decreased by 32 percent in men and by 31 percent in women over the study period.
Cancer survival rates in the UK lag behind the EU
The team explains that deaths from heart disease and stroke have decreased across the population, even without diabetes.
Dr. Jonathan Pearson-Stuttard, lead author of the study, said, “Improvements in risk factors such as smoking and blood pressure, as well as advances in medical treatments, have contributed to sharp decreases in deaths from heart disease and stroke. The improvements were even greater in people with diabetes. This has resulted in vascular disease accounting for around 25 percent of all deaths in diabetics, compared to 45 percent 20 years ago.
In contrast, improvements in cancer death rates have been much more modest, with improvements in diabetics lagging behind the general population. It is striking that cancer is the leading cause of death in England today in people with diabetes and is the leading cause of death compared to people without diabetes. In addition, the UK continues to lag behind other EU countries in terms of cancer survival rates. “
The results also showed that people with diabetes were more likely to die of dementia, liver disease, or respiratory disease than people without diabetes in 2018.
The death rates in diabetics were higher than in diabetics without diabetes for almost all of the causes examined. Mortality rates for liver disease and dementia were twice as high in diabetics as in those without diabetes in 2018, while death rates for respiratory diseases were 80 percent higher.
Increased risk of diabetes
The research team says that people with diabetes have an up to two-fold increased risk of dementia compared to people without diabetes. The exact link for this is unclear, but there are several common risk factors such as smoking, obesity and poor diet between diabetes and dementia.
The rise in liver disease could be due to the high levels of obesity in people with diabetes and higher alcohol consumption.
This study is another reminder that diabetes still leads to a host of other problems as people die less from cardiovascular disease. Professor Edward Gregg study author
The team is calling for an update to diabetes management guidelines to ensure patients and clinicians are aware of the range of conditions that are at higher risk for cancer, dementia, and liver disease.
They add that the reasons that cancer is the leading cause of death are unclear, but could be related to the fact that people with diabetes are more likely to be overweight and that being overweight is a leading risk factor for cancer.
The team also highlights limitations of the study, such as the inability to differentiate between type 1 and 2 diabetes in the data and the fact that around 20 percent of people with diabetes in the UK go undiagnosed.
Professor Edward Gregg, lead author on the study, added, “This study is another reminder that diabetes still leads to a variety of other problems as people die of fewer cardiovascular diseases. The diversification of the major causes of death here included cancer, dementia and respiratory diseases. This and the current experience with COVID-19 are a reminder that we have to think more and more carefully about what prevention means for people with diabetes. “
“Trends in the predominant causes of death among people with and without diabetes in England from 2001 to 2018: An Epidemiological Analysis of Linked Primary Care Records” is published in The Lancet Diabetes and Endocrinology
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